Efforts to Improve Colorectal Cancer Screening Rates

This project attempts to describe the efficacy of FOBT (guaiac-based FOBT & fecal immunochemical test), explore FluFOBT program, and examine the relationship between advanced practice registered nurse knowledge level about CRC screening recommendation guideline and self-reported referral rates in efforts to improve CRC screening rates

Menstrually related mood disorders and a history of abuse:moderators of pain sensitivity.

Objective. Women with menstrually related mood disorders (MRMD) have substantial rates of physical and sexual abuse, are more sensitive to experimental pain stimuli than women without MRMD, and endorse increased sensitivity to interpersonal rejection (emotional pain) in the premenstrual phase. For the first time, this study examined physical and emotional pain sensitivity in women with MRMD and in non-MRMD controls as a function of abuse history. Methods. A total of 126 women (63 MRMD, 34 with an abuse history and 63 non-MRMD, 31 with an abuse history) were evaluated for: (1) sensitivity to cold pressor and forearm ischemic pain; (2) emotional pain sensitivity based on daily prospective ratings of sensitivity to interpersonal rejection; and (3) basal plasma cortisol and norepinephrine (NE) concentrations. Exploratory analyses examined relationships between plasma cortisol and NE concentrations and physical pain sensitivity. Results. Women with MRMD and an abuse history showed increased sensitivity to both cold pressor and ischemic pain and lower basal cortisol concentrations, an effect not seen in the non-MRMD women. However, non-MRMD women with an abuse history showed increased sensitivity to emotional pain relative to non-MRMD women with no such history. In all subjects, the expected relationship between greater plasma cortisol concentration and reduced sensitivity to physical pain was observed. While only in women with MRMD, plasma NE predicted pain sensitivity. Conclusions. MRMD status moderates the effect of a history of abuse on both physical and emotional pain sensitivity. The results also suggest that the hypocortisolemia documented in the women with MRMD and an abuse history may contribute to their greater sensitivity to noxious experimental stimuli. This study adds to a growing body of evidence suggesting that a history of abuse may identify a clinically distinct subgroup of women with MRMD

A Biopsychosocial Conceptual Framework of Postpartum Depression Risk in Immigrant and U.S.-born Latina Mothers in the United States

In this review, we offer a conceptual framework that identifies risk factors of postpartum depression (PPD) in immigrant and U.S.-born Latinas in the U.S. by focusing on psychosocial and neuroendocrine factors. While the evidence of the impact psychosocial stressors have on the development of PPD have been well documented, less is known about the biological etiology of PPD or how these complex stressors jointly increase the risk of PPD in immigrant and U.S.-born Latinas in the U.S

Neurosteroids in the context of stress: Implications for depressive disorders

Animal models indicate that the neuroactive steroids 3α,5α-THP (allopregnanolone) and 3α,5α-THDOC (allotetrahydroDOC) are stress responsive, serving as homeostatic mechanisms in restoring normal GABAergic and hypothalamic-pituitary-adrenal (HPA) function following stress. While neurosteroid increases to stress are adaptive in the short term, animal models of chronic stress and depression find lower brain and plasma neurosteroid concentrations and alterations in neurosteroid responses to acute stressors. It has been suggested that disruption in this homeostatic mechanism may play a pathogenic role in some psychiatric disorders related to stress. In humans, neurosteroid depletion is consistently documented in patients with current depression and may reflect their greater chronic stress. Women with the depressive disorder, premenstrual dysphoric disorder (PMDD), have greater daily stress and a greater rate of traumatic stress. While results on baseline concentrations of neuroactive steroids in PMDD are mixed, PMDD women have diminished functional sensitivity of GABAA receptors and our laboratory has found blunted allopregnanolone responses to mental stress relative to non-PMDD controls. Similarly, euthymic women with histories of clinical depression, which may represent a large proportion of PMDD women, show more severe dysphoric mood symptoms and blunted allopregnanolone responses to stress versus never-depressed women. It is suggested that failure to mount an appropriate allopregnanolone response to stress may reflect the price of repeated biological adaptations to the increased life stress that is well documented in depressive disorders and altered allopregnanolone stress responsivity may also contribute to the dysregulation seen in HPA axis function in depression

Neurosteroid, GABAergic and hypothalamic pituitary adrenal (HPA) axis regulation: what is the current state of knowledge in humans?

A robust epidemiological literature suggests an association between chronic stress and the development of affective disorders. However, the precise biological underpinnings of this relationship remain elusive. Central to the human response and adaptation to stress, activation and inhibition of the hypothalamic pituitary adrenal (HPA) axis involves a multi-level, multi-system, neurobiological stress response which is as comprehensive in its complexity as it is precarious. Dysregulation in this complex system has implications for human stress related illness

Mechanisms underlying hemodynamic and neuroendocrine stress reactivity at different phases of the menstrual cycle

This study examined the association of menstrual cycle phase with stress reactivity as well as the hormonal and neuroendocrine mechanisms contributing to cycle effects. Fifty-seven women underwent a modified Trier Social Stress Test during the early follicular, late follicular, and luteal phases of the menstrual cycle. Greater increases in cardiac index (CI) and greater decreases in vascular resistance index (VRI) during speech were observed in the luteal phase relative to other phases, while greater increases in epinephrine (EPI) was observed during the late follicular and luteal phases compared to the early follicular phase. Luteal phase estradiol predicted luteal EPI reactivity but not CI or VRI reactivity, while luteal phase EPI reactivity predicted luteal phase CI and VRI reactivity. Thus, cycle-related changes in EPI reactivity may be a stronger determinant of cycle effects on hemodynamic reactivity than sex hormones per se

The Role of Chronic Psychosocial Stress in Explaining Racial Differences in Stress Reactivity and Pain Sensitivity

To examine the role of psychosocial factors in mediating the relationship between African American (AA) race and both increased pain sensitivity and blunted stress reactivity

Hypothalamic-Pituitary-Thyroid Axis Function in Women With a Menstrually Related Mood Disorder: Association With Histories of Sexual Abuse

We previously reported a unique hypothalamic-pituitary-thyroid (HPT) axis profile in women with a menstrually related mood disorder (MRMD) who also had a history of sexual abuse (SA). In the present study, we sought to extend that work by examining the association of a SA history with HPT-axis disturbance in both MRMD and non-MRMD women

Vision Self-Mmanagement For Older Adults: a Randomised Controlled Trial

Background/aims Ageing of the population will result in unprecedented numbers of older adults living with age-related vision loss (ARVL). Self-management models improve health outcomes and reduce healthcare costs; however, the principles have rarely been applied in low vision services. Methods A two-armed randomised controlled trial of older adults (n=77) with ARVL compared ‘usual care’ provided by a not-for-profit community agency with an extended model of care (usual care+self-management group intervention). The primary outcome variable (participation in life situations) was measured using the Activity Card Sort. Secondary outcome measures examined general health and vision-specific domains. Results The intention-to-treat analysis demonstrated that the extended model produced significantly better participation in life situations at post-test when compared with the usual care only group. Gains were made regardless of whether participants were, or were not, depressed at baseline. The addition of the self-management group was also successful in significantly reducing depression, increasing physical and mental health, generalised and domain-specific self-efficacy, and adjustment to ARVL. With the exception of adjustment and mental health, differences were still apparent at 12 weeks\u27 follow-up. Conclusion Addition of self-management significantly improved general health and vision-specific rehabilitation outcomes for older adults with ARVL

Eradication of poliomyelitis in South Africa

An international campaign under the leadership of the World Health Organisation is underway to eradicate polio from the world by the year 2000. South Africa may already be free of polio. However, to ensure eradication we need to move from a polio control programme to a polio eradication programme. This necessitates the institution of a surveillance programme for acute flaccid paralysis (AFP) and improvement of the delivery of polio vaccine. All children with AFP (including those with suspected GuillainBarre syndrome) should be investigated with stool culture to exclude polio. Primary care services need strengthening so that oral polio vaccine coverage greater than 90% is achieved in all regions by all authorities. Outbreak response activities need to be developed. Consideration needs to be given to national immunisation days and mopping-up activities